With almost 200,000 enrollees nationwide, ADAPs reach over a third of all people with HIV receiving care in the United States.

ADAPs are subject to annual federal appropriations. Congress funds the ADAPs through Part B of the Ryan White Program, which is allocated by formula to states. ADAPs also receive some state funding but this support is highly variable and largely dependent on state and local decisions and resources.

Jurisdictions that receive ADAP funding include all 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, Federated States of Micronesia, Marshall Islands, and the Northern Mariana Islands.

Each state operates its own ADAP, including determining eligibility criteria and other program elements, resulting in significant variation in ADAPs across the country.

All ADAPs participate in the 340B program, enabling them to purchase drugs at or below the statutorily defined 340B ceiling price. Some state ADAPs also purchase drugs directly from wholesalers or through a pharmacy network.

Some ADAPs also use ADAP earmark funding to purchase health insurance and/or pay insurance premiums, co-payments, or deductibles for people with HIV/AIDS.

Background:

ADAPs began serving clients in 1987, when Congress first appropriated funds to help states purchase the only approved antiretroviral (ARV) drug available at the time. In 1990, they were incorporated into Part B of the newly enacted Ryan White Comprehensive AIDS Resources Emergency (CARE) Act, now known as the Ryan White Program.

In 2003 the Medicare Modernization Act was implemented, which added the Medicare Part D prescription drug benefit to the program. Because ADAPs fall under the same payer-of-last-resort designation as the rest of the Ryan White Program, ADAPs must ensure that any Medicare Part D-eligible client is enrolled in Part D.

ADAP Crisis:

In 2010, ADAPs across the nation experienced a state of fiscal crisis that left thousands of HIV patients unable to access the program. ADAPs across the country had waiting lists ranging from dozens to hundreds of people. The problem reached an all-time high of over 9,000 individuals on ADAP waiting lists in 2010.

A convergence of factors has brought them to this place.The economic recession of the past several years has left many Americans without health insurance. This and other factors have increased the number of people who are in need of the ADAP program to access their medications.

Meanwhile, states encountered budgetary constraints and deficits, which has led to efforts to trim back the cost of programs such as ADAP. Finally, federal lawmakers - facing similar budget constraints – have decreased funding for the program, leaving it unable to match the rate of increase in the program.

As public pressure to reduce the size of the waiting lists mounted, states responded with a number of tactics to make the visible waiting lists disappear.

Some state ADAPs lowered their eligibility criteria, making fewer individuals eligible for the program. Other states reduced their ADAP formulary, both to reduce costs to the program and to reduce the number of individuals who can access their medications through it. Some states capped enrollment, dis-enrolled clients, or instituted expenditure caps or client cost-sharing techniques. All of these tactics left individuals unable to receive the life-saving medications they depend upon.

Pressure on ADAP resources has also increased substantially since the introduction of Highly Active Antiretroviral Therapy (HAART) and other combination HIV medications. Though these drugs have offered life-saving and more convenient options to HIV patients, the costs of the medications are significant. Typical costs for antiretroviral medication for an HIV patient can be upwards of $12,000 per year or more. Additional costs of medications to address opportunistic infections, side affects, and other treatment issues may also be incurred.

Currently:

As of March 2013, there are still 63 individuals in 4 states on ADAP waiting lists. However, there are many more who still do not have adequate access to their medications due to eligibility changes in the program.

To learn more about how individuals who are unable to access their medications can recieve help, please visit our Patient Assistance page under the provider resources section of this website.

More:

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